Healthcare Coordination of Care has many moving parts

As with most things complex, the basics are pretty simple.

Patient calls in/arrives, a Case is set up. 

First things first – patients have one desire which is to get well, hospitals have scarce resources, doctors are busy.

So, a good strategy is to start discharge planning from the start.

Once, Pt has been through Intake, Assessment, Diagnosis, it’s mostly all about Tx Planning and Monitoring going forward.

We all know about the problems of diagnosis.

Few patients meet all of the criteria for any disease. Some of their symptoms/signs are representative of other diseases. But, Tx plans are typically disease-specific. The application of one Tx template will improve some of the symptoms/signs of one disease to the possible detriment of another condition, so, at the end of the day, blended Tx plans are often needed.

The usual result is Pt will have a number of objectives/goals some of which are more important than others. Tx Plan monitoring needs to focus on attainment of objectives and no two Pts are likely to have the same set of objectives. At a practical level, it is not necessary to meet all objectives in order to discharge.

Coordination of care means aligning all interventions to attaining objectives.

In a hospital, each Pt is likely to receive services from a number of healthcare professionals so Case is the way to go (e.g. call it e-charting if you like). Case gives you at-a-glance access to past interventions and, depending on the sophistication of the implementation, may provide decision support in respect of current and future interventions.

Case gives you a reverse chronological Hx of interventions, each with a date/time-stamp and “signature” of the performing resource. You get to see data, as it was, on the form versions that were in service at the time the data was collected.

Automated resource allocation, levelling and balancing plus background Orchestration and Governance ensures that things do not fall between the cracks and that there are not unwanted significant time delays between interventions.

Interoperability is important “icing on the cake”, linking up local and remote 3rd party systems and applications and providing multi-directional data exchange.


Management consultant and process control engineer (MSc EE) with a focus on bridging the gap between operations and strategy in the areas of critical infrastructure protection, major crimes case management, healthcare services delivery, and b2b/b2c/b2d transactions. (C) 2010-2019 Karl Walter Keirstead, P. Eng. All rights reserved. The opinions expressed here are those of the author, and are not connected with Jay-Kell Technologies Inc, Civerex Systems Inc. (Canada), Civerex Systems Inc. (USA) or CvX Productions.
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4 Responses to Healthcare Coordination of Care has many moving parts

  1. Truly Helpful information.

    Liked by 1 person

  2. robertdowney says:

    I have a basic knowledge about Hospital Management software. After i reading your blog i have a clear view about Hospital Management software.


  3. robertdowney says:

    Patient Information Management System (PIMS) helps in managing patients, hospital, billing, claims, and tracks/monitors the patient information in the real time.

    Liked by 1 person

    • @Robert. . . Thank you for commenting. Amazing to me that folks occasionally go back several years to read/revisit these blog posts.

      Agree . . . . The purpose of EHRs is to let staff go to one place (the electronic chart) to see the history of interventions – before they administer the next intervention. (allergies, contraindications, avoiding performing interventions already performed, etc.)

      The way everything should thread together is that the patient is put on a administrative/clinical workflow as they enter the facility and the software posts needed interventions in logical/time manner to an Orders InTray to the attention of staff

      It’s not practical to have or try to build a single end-to-end workflow so staff frequently go to a menu of services and stream the patient onto new mini-workflows as others reach their end points.

      It is the PIMS that pulls everything together. Or, supposed to pull everything together. Unfortunately, most healthcare facilities do not have software that helps staff manage patients the way staff would like to manage patients.

      It’s not exclusively the lack of workflow templates that is the problem – the user interfaces at some of the software systems out there do not meet the requirement that they make healthcare delivery service easier with the software than without the software.


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